I.

II.

Antitussives
a. Uses/Indications
i. What are antitussive medications used for?
1. They treat uncomfortable, unproductive cough.
b. Action
i. What do antitussives do?
1. Antitussives treat uncomfortable, unproductive cough by suppressing the cough
reex.
ii. How is the cough reflex suppressed?
1. Centrally they work on the medullary cough center of the brain to depress the
cough reflex.
a. Traditional antitussives: codeine, hydrocodone, and dextromethorphan.
2. Locally acts as a local anesthetic on the respiratory passages, lungs, and pleurae,
preventing the stretch receptors from triggering a cough reex.
a. Other antitussives: benzonatate
c. Contraindications Who should not take drug?
i. Who should not take antitussives?
1. Pt. who needs to cough to maintain their airway
a. Postoperative pt
2. Specifics for central acting antitussives
a. Head injury
b. CNS depression
ii. Caution should be used in patients with
1. Asthma & Emphysema
2. D/t risk for secretion accumulation which could lead to loss of respiratory reserve
d. Side effects
i. Dries mucous membranes.
ii. GI Upset
1. Nausea
2. Constipation (d/t drying effect)
iii. Thickens mucous
iv. CNS
1. Drowsiness & Sedation
2. Headache
3. Dizziness
v. Feeling congested
e. Interactions
i. DO NOT use with MAOI
1. Causes hypotension, fever, nausea, myoclonic jerks, and coma.
Decongestants
a. Uses
i. Decrease nasal congestion related to the common cold, sinusitis, and allergic rhinitis.
ii. Relieve the pain and congestion of otitis media
b. Decongestants decrease the overproduction of secretions.
i. Causes local vasoconstriction to the upper respiratory tract
ii. Shrinks swollen mucous membranesOpens clogged nasal passages
iii. Provides relief from discomfort of having a blocked nose
iv. Promotes drainage of secretions
v. Improved airow
c. Contraindications
i. Conditions that might be exacerbated by sympathetic activity because nasal
decongestants have adrenergic properties.

III.

IV.

1. glaucoma
2. hypertension
3. diabetes
4. thyroid disease
5. coronary disease
6. prostate problems
d. Adverse effect
i. Frequent or prolonged use results in rebound congestion (rhinitis medicamentosa)
1. Rebound vasodilation person becomes even more congested if med. is
overused
e. Decongestants are usually adrenergics or sympathomimetics
Topical Nasal Decongestant
a. Examples: phedrine (Pretz-D), oxymetazoline (Afrin, Allerest, and others), phenylephrine
(Coricidin and many others), tetrahydrozoline (Tyzine), and xylometazoline (Otrivin)
b. Uses What are they used for?
i. [STATED ABOVE]
ii. Used to dilate the nares during medical examination
c. Action How do they work?
i. Topical decongestants are sympathomimetics
1. Sympathomimetics imitate the effects of the sympathetic nervous system causing
a. Vasoconstriction which decreases edema and inammation of the nasal
membranes
d. Pharmacokinetics
i. Nasal sprays are not systemically absorbed & do not have systemic effects
ii. Take effect very quickly
e. Contraindications and Cautions
i. Caution should be used when
1. Mucous membrane has a lesion or erosion - could lead to systemic absorption
ii. Do not use topical nasal steroid decongestant w/ infection
f. Side effects
i. local stinging and burning - occur the rst few times the drug is used; D/C if symptom
doesnt resolve after the first few uses
ii. Rebound congestion if used for longer than 3 to 5 days
iii. Sympathomimetic effects
1. increased pulse
2. Increases blood pressure
3. urinary retention
4. Cool clammy skin
g. Patient teaching
i. Clear the nasal passages before use
ii. Tilt the head back when applying the drops or spray, and to keep it tilted back for a few
seconds after administration.
iii. DO NOT use nasal decongestants for longer than 5 days
iv. Use of a humidier, increased uid intake, cool environment, avoidance of smoke-lled
areas
Oral Decongestants pseudoephedrine
a. Uses
i. [Stated above]
b. Action How do they work?
i. Shrink the nasal mucous membrane by stimulating the alpha-adrenergic receptors in the
nasal mucous membranes.
1. Decreases membrane size

c.

d.
e.

f.

2. Promotes drainage of the sinuses

3. Improving airow
Pharmacokinetics
i. widely distributed in the body (systemic)
ii. Takes 20-45 min. to reach peak levels
Contraindications
i. [see above]
Adverse effects
i. Anxiety
ii. Tenseness
iii. Restlessness
iv. Tremors
v. Hypertension
vi. Arrhythmias
vii. Sweating
viii. Pallor
Patient teaching
i. Do not use for longer than 1 week